A mortal analogy

FAMILY planning was not something you talked about. Peopl said we were corrupting the morals of society in addition to interfering with people's very private affairs.

"When we received our first grant from government, we had to promise to keep it secret, for they fered the political fallout if it were made known."


These are the words of one of the pioneers of family planning in Sri Lanka whom I met last month in Colombo. Elsewhere in the world a similar story is told over and over again by those who, 30 or 40 years ago, suggested that contraceptives be made available to those who wished to plan their families.

What is interesting about these stories is that they are frightfully similar to those told by people spearheading the AIDS prevention effort. They, too, encounter hostility when openly addressing their concerns. It seems that questions dealing with human sexuality are systematically dodged or denied. It may be wise to look closely at the analogy.


When the first family planners talked about birth control, they were accused of promoting promiscuity, amoral behavior, going against God's will and corrupting youth. There was a phase of denial: "Women are made to have children," "We need more citizens" or "It should be left to doctors to worry about."

Then came a half-hearted response based on population growth rate projections -- contraceptives and counseling were quietly offered in "some" clinics.

When government planners finally realized the impact of population growth on national economics and future well-being, stringent measures were taken to "bring down" the birth rate. In so doing, violations of basic human rights and dignity were often the result. Some governments began to "manage" human reproduction by law or coercion. Even today, sterilization is one of the world's most common means of birth control.

In many countries today we are witnessing the first phase -- denial -- of the AIDS threat: "It doesn't concern me." "It can't happen here." "It is only for the promiscuous, the marginal." Heads in the sand, we refuse to see the tragedy unfolding in our lives and the lives of our children and grandchildren.

Most nations do have a foot in phase two -- beginning to act in small ways: cleaning up the blood supply, undertaking occasional information campaigns and financing counseling efforts.

It is not enough. There has been no measurable success in encouraging behavioral change worldwide. HIV continues to spread from country to country, infecting rich, poor, male and female, adults and children.

As with family planning, governments have been slow to respond. Turning a blind eye to the social and economic consequences of the virus, they avoid taking a strong policy stand on such a "controversial" subject.

For them, AIDS is a medical issue, just as was family planning. We know this is absurd. Anything that requires behavioral change is a social policy concern. And the AIDS pandemic is rapidly becoming a major financial and development constraint as well.


The United Nations development program does well to point out that the epidemic will force a rethinking of approaches to development. In certain African countries, entire villages are without farmers; the working generation is dead or dying.

In industrialized countries studies demonstrate that few among us have changed our behavior. Safe sex is not widely practiced in any age group. Yet the HIV can remain within us for years without any visible symptoms and be passed on, unwittingly, to others.

When Margaret Sanger dared talk about family planning (circa 1930), world population stood at 2 billion. Today, we number 5.4 billion. If, as was the case with family planning, leaders wait until the AIDS crisis has ballooned to take action, the consequences defy the imagination.

Perdita Huston is a free-lance writer based in London.